Methods of applying a suture cinch

Abstract

A two-part suture cinch includes a collar and a plug. A cinch applicator is also provided, and includes an elongate tubular member, a plunger engaged within the distal end of the tubular member, a flexible shaft extending through the tubular member and plunger, and a proximal handle for moving the shaft longitudinally relative to the tubular member. The plunger includes a distal housing for the collar of the cinch, and the plug is coupled to the distal end of the flexible shaft. The suture is thread through the collar and a portion of the applicator. Operation of the applicator draws the plug into the collar and clamps the suture between the plug and collar. In addition, once the plug is coupled in to the collar, the plunger is displaced proximally to release the two-part cinch form the applicator. A method for applying the cinch is also provided.

What is claimed is: 
     
       1. A method of applying a suture cinch to a length of suture, wherein a first portion of the suture is inserted in tissue and a second portion of the suture is free of the tissue, comprising:
 a) providing a cinch applicator loaded with a two-part cinch including a collar and plug, said applicator including a tubular element defining a side window, a shaft extending through said tubular element, said distal end of said tubular element provided with a plunger engaged in a longitudinal position and fixed rotational orientation relative to said tubular element, said plunger including an opening aligned with said side window, a cutting edge bordering said opening, and a housing, said collar engaged within said housing of said plunger and said plug provided at a distal end of said shaft; 
 b) providing a suture threader extending through and movable within a pathway, the pathway defined through each of an open distal end of said collar, longitudinally within said tubular element, said opening in said plunger, and said window in said tubular element; 
 c) using said suture threader to thread said proximal portion of said second portion of suture through the pathway; 
 d) first operating said applicator to draw said plug into said collar and clamp the suture between said plug and collar; 
 e) second operating said applicator to release said shaft from said plug; and 
 f) third operating said applicator to retract said plunger and thereby disengage the coupled collar and plug from the distal end of said applicator. 
 
     
     
       2. A method according to  claim 1 , wherein said second operating and third operating occur as a continuous process. 
     
     
       3. A method according to  claim 1 , wherein said first operating, second operating, and third operating occur as a continuous process. 
     
     
       4. A method according to  claim 1 , wherein said first, second and third operating are all effected by retraction of the shaft relative to the tubular member. 
     
     
       5. A method according to  claim 1 , wherein in the provided applicator a portion of said plunger co-extends with said collar. 
     
     
       6. A method according to  claim 1 , wherein retraction of said plunger releases said collar from engagement with said plunger. 
     
     
       7. A method according to  claim 1 , further comprising advancing said applicator relative to the suture to move said collar against the tissue. 
     
     
       8. A method according to  claim 1 , wherein said third operating causes said cutting edge of said plunger to sever the suture. 
     
     
       9. A method according to  claim 1 , wherein refraction of said plunger releases said collar from engagement with said plunger and causes said cutting edge to sever the second portion of the suture from the first portion of the suture. 
     
     
       10. A method according to  claim 1 , wherein said two-part cinch has a length, and the suture laterally attaches to said cinch along a central portion of said length of said cinch. 
     
     
       11. A method according to  claim 1 , further comprising passing the applicator through a working channel of an endoscope to reach the tissue. 
     
     
       12. A method according to  claim 11 , wherein said applicator is flexible, and the endoscope is flexed, and the working channel is non-straight while the endoscope is flexed. 
     
     
       13. A method according to  claim 1 , further comprising:
 passing the applicator through a working channel of an endoscope to reach the tissue, wherein the suture threader extends exterior to and parallel to the applicator within the same working channel as the applicator. 
 
     
     
       14. A method according to  claim 13 , actuating said suture threader from said proximal end of the endoscope to thread suture into the pathway while the cinch collar is located even with or distal a distal face of the endoscope. 
     
     
       15. A method according to  claim 13 , actuating said suture threader from said proximal end of the endoscope to thread suture into the pathway while the cinch plug is located distal a distal face of the endoscope. 
     
     
       16. A method of applying a suture cinch to a length of suture coupled to tissue of a patient, comprising:
 a) providing a cinch applicator loaded with a suture cinch including a first element having a longitudinal throughbore and a second element, said applicator provided with,
 a distal housing in which said first element of said suture cinch is located and a side window is provided proximal said first and second elements, and 
 said cinch applicator operable to retract said second element from a first location distally displaced relative to said first element to a second location within said longitudinal throughbore of said first element, 
 a pathway defined between said longitudinal throughbore and said side window and external said second element; 
 
 b) inserting a suture threader through said pathway in a distal direction, wherein when inserted said suture threader has a portion extending within said pathway, a distal end provided with an opening located distal of said cinch element, and a portion located outside said window; 
 c) advancing a portion of the length of suture through said opening in said suture threader; 
 d) retracting said suture threader from said pathway in a proximal direction, whereby the portion of the length of suture is drawn back through said pathway by said suture threader; and 
 e) operating said cinch applicator to retract said second element into said first element and thereby lock said suture cinch about said suture. 
 
     
     
       17. A method according to  claim 16 , further comprising:
 further operating said cinch applicator to sever said suture proximal of said element of said suture cinch. 
 
     
     
       18. A method according to  claim 16 , wherein:
 said advancing a portion of the length of suture through said opening in said suture threader and said retracting said suture threader are both performed outside the patient. 
 
     
     
       19. A method according to  claim 16 , wherein:
 said advancing a portion of the length of suture through said opening in said suture threader is performed in vivo. 
 
     
     
       20. A method according to  claim 19 , wherein:
 said applicator extends through a first working channel of an endoscope, and said suture threader extends alongside said applicator within said first working channel. 
 
     
     
       21. A method according of  claim 16 , wherein:
 said opening of said suture threader is collapsible in dimension when drawn through the pathway. 
 
     
     
       22. A method according to  claim 16 , wherein:
 when the portion of the length of suture is drawn back through said pathway by said suture threader, the portion of the length of suture is doubled-over by said act of being drawn back into said pathway.